ORAL HEALTH AMERICA

October 28, 2014

SEALS: Try It, You Will Like It

/Oral Health America @Smile4Health

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OUR MISSION

Oral Health America’s mission is to change lives by

connecting communities

with resources to increase access to care,

education and advocacy for all Americans,

especially those most vulnerable.

OHA PRIORITIES

ADVOCACYEDUCATIONACCESS

OHA’s Programs and Campaigns are designed to improve

access to care, oral health literacy and policies that

prioritize the impact of oral health on the overall health of all

Americans – particularly those most vulnerable.

OUR PROGRAMS

Provides oral disease preventive

services in school-linked settings

Served 440,000 kids through 193

programs in 43 states during 2013-2014 school year

Facilitated donation of more than 500,000

units of dental product

Provided nearly $400K grants plus

technical assistance to treatment partners

On schedule to seal 2 million teeth by 2015 (5 years ahead of schedule)

Focused on the oral health needs of

community-dwelling older

adults and their caregivers

Educates older

adults/caregivers re: importance of oral health + connects with resources for care

Tooth Wisdom: Get Smart About

Your Mouth workshops in pilot

OUR CAMPAIGNS

Educate the public, including policy makers, about the importance of oral health for overall health

Emphasize the need to prioritize oral disease alongside other serious health conditions

Advocate for policies that positively impact programs and stakeholders

Current campaigns include:

Technical Assistance

Sealant Initiative

Product Donation

Grant Funding

Supportive Research

SEALS: Try It, You Will Like It

Smiles Across America Webinar

October 28, 2014

Contributors

Clare Larkin, RDH MSEd

Minnesota Department of Health Oral Health Program

Prevention Coordinator

Bilquis Khan Jiwani, Msc. (Epi), MBA, Msc. (Stats)

Minnesota Department of Health Oral Health Program

Program Evaluator

Merry Jo Thoele, MPH RDH

Minnesota Department of Health Oral Health Program

Program Director

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Presentation Outline

• History/background of SEALS

• Purpose of SEALS

• Benefits to School-based sealant programs (SBSP)

using SEALS

• Program efficiency when using SEALS

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SEALS

S = Sealant

E = Efficiency

A = Assessment for

L = Locals and

S = States

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SEALS : Background, Overview

Developed in the early 2000s at Centers for Disease Control and Prevention (CDC) for, and in conjunction with,Wisconsin’s Seal-A-Smile program

At the time:

• no centralized method for program evaluation

• limited state data existed

• programs desired an automated means to collect health status, cost, and logistics data to allow for analysis

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SEALS…What Is It?

• Easy-to-use Microsoft Excel-based dental sealant

program management tool

• Provided at no-cost by CDC Division of Oral

Health

• Includes:

– User’s manual (a guide for clinical staff)

– Technical Notes manual (a guide for program

administration)

– Ready-made data collection forms

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SEALS…What Does It Do?

• Automates capture, storage, and analysis of data:

– oral health status of participating children

– types and numbers of services delivered at

school events

– costs and logistics of events, e.g., personnel,

equipment, materials, and travel

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Fulfills Program-level Needs

• Measures the cost and impact of a program and

how to efficiently allocate scarce resources

• Documents that the program is a good use of grant

money received; shows if program practices are

yielding best results

• Secures additional support from funders to serve

more children

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Fulfills State-level and Funder-level Need

• Compares local school-based sealant programs

(SBSP) on costs, output, and efficiency

• Helps in formulating goals and assessing less

efficient programs

• Some states use SEALS data to allocate funding

among programs

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Generates Three Levels of Analysis

• Produces summary and performance measures

for a single school sealant program/event

• Compares reports across all schools

• Produces statewide values of summary and

performance measures

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Program Name:

This is your

program’s name, for

example Great City

Community Dental

Clinic (GCCDC)

Event/Site Name:

“Event” is

equivalent to the

school or facility

name

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ID #:

Assign a separate

number or identifier

for each child

An easy pattern is:

1st student screened = 001

2nd student screened = 002

etc.

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Race/Ethnicity:

Check all that apply

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Special Health Care Needs:

Determination is based on parent/guardian response(s) on the child’s health history, not on SBSP staff observation

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10. Special Health Care Needs: (0 = No 1 = Yes) 2

Does your child:

1. Use medicine prescribed by a doctor?___ YES ___ NO If YES, what medication(s): _______________________________________

2. Need or use more medical care than other children the same age? ___YES ___ NO

3. Have trouble doing things most children the same age can do? ___ YES ___ NO

4. Need or get special therapy, such as physical therapy, occupational therapy or speech therapy? ___YES ___NO

5. Need counseling or treatment for behavior problems, emotional problems, or delays in walking, talking or activities other children the same age can do? ___YES ___ NO

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

6. Has this problem lasted or is it expected to last at least 12 months? ___YES ___ NO

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Medicaid/SCHIP

Status:

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Section I: completed at

the first visit.

Section II: completed at

the first visit if screening,

sealant application and

one application of

fluoride are done on the

same day.

Section III: completed at

“follow-up” (also known

as the “retention check”

visit).

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The Information Described So Far …

Helps to determine:

• Oral health status of participating children

• If program is delivering services to children with a high risk of dental decay or who lack access to care?

• If program is targeting schools with children at high risk of dental decay?

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SEALS EVENT-LEVEL DATA COLLECTION FORM

**** Please complete one form per site. ****

1. Program name: _____________________ 2. Event name: ______________________

3. School year: _____________________ (Enter the 4 digit year that the school year began; for example, for the ’02-’03 school year, enter 2002.)

4. Site type: _________ 0 = School 4 = Tribal health center

1 = Community site 5 = Community health center

2 = Dental hygiene program 6 = Other ________

3 = Dental school

5. Number of dental chairs used for:

a. screening _______ b. sealant delivery ________ c. retention checks _______

6. Total hours organizing event, not spent at site: __________

7. Total time spent at site (in hours) for:

a. screening ______________ c. retention rate checks ____________

b. sealant delivery ____________ d. setup and breakdown/cleanup _________

8. a. Number of child hours of oral health education offered: ___________

b. Number of children receiving oral health education: __________

9. Event dates - Choose a single representative date for each of the following:

a. screening ______________ b. sealant placement/fluoride delivery _____________

a. follow-up (e.g. retention check, follow-up on referral) _________________ (Dates should be entered in 8-digit format, including slashes. For example, January 1, 2000 should be entered 01/01/2000. Enter 12/31/1998 as the date for phases of the program that have not yet or will not occur.)

10. Criteria used to determine caries status: _______ 0 = ICDAS 4 = Other system that distinguishes sound surfaces from non-cavitated

1 = BSS 5 = Other system that classifies surfaces with non-cavitated caries as sound

2 = WHO

All Dental Personnel*

Hours

(a)

All Other Personnel**

Hours

(b)

11. Screening

12. Sealant delivery

13. Retention check

Total Personnel Hours

*Dental personnel include dentists, hygienists, and dental assistants

** Other personnel include data entry clerks, parent volunteers, etc.

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Items On Event-level Data Collection Form

• Type of population targeted (% of children in free

or reduced price lunch program)

• Targeted grade levels

• Targeted type of permanent teeth

• Type of consent

• Number of consent forms distributed

• Type of sealant material used

• Sealant placement procedure

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Items On Event-level Data Collection Form (Cont.)

• Total hours spent on organizing the event

• Total hours spent at the site for screening, sealant

delivery, retention checks, setup and

breakdown/cleanup

• Total personnel hours

• Number of child hours of oral health education

offered

• Number of dental chairs used

• Value of total resources used

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After you have completed the child and event-level forms, how do you make your data talk

and help you tell a story?

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SEALS

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An Evaluation and Benchmarking

Tool for Administrators of

Community Sealant Programs

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User’s Manual

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Technical Notes Manual

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Use Data to Support Your Statements

• Don’t just say “We are preventing

decay”.

• Show how “We are preventing

treatment costs”.

What Do These Reports Give Us?

• General demographics

• Summary of effectiveness in targeting high-risk

populations that lack access to care

• Summary of effectiveness of targeting high-risk

teeth

• Summary of services delivered

• Summary of quality of services delivered

• Summary of efficiency of input usage

SBSP Cost AnalysisUsing SEALS

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Cost Analysis

• Cost analysis provides a foundation for

various economic evaluations which

can assist programs in understanding

intervention costs and benefits.

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SEALS Cost Data

• SEALS calculates

Cost per child screened

Cost per child sealed

Cost per tooth sealed

Cost per cavity averted

Averted caries per child

Averted caries per sealant

Total cost of the program

• SEALS shows whether the program is cost-efficient or not

In a Nutshell

SEALS helps you “package” your data to:

– Assess your program progress, efficiency and

effectiveness

– Report to legislators, state oral health coalition

and other stakeholders

– Write grant proposals to private foundations

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How Do I Obtain the SEALS Program Management Tool?

Contact Dr. Susan Griffin

Health Economist

Centers for Disease Control and Prevention

sig1@cdc.gov

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Acknowledgement

• Susan Griffin, PhD, Health EconomistCenters for Disease Control and Prevention Division of Oral Health

• Kari Jones, PhD, Health EconomistQuantitative Health Research, Inc.

• Matt Crespin, MPH RDH, Associate Director-Children’s Health Alliance of Wisconsin, Seal-A-Smile (SAS) program

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Contact Information

Clare Larkinclare.larkin@state.mn.us

651.201.4230

Bilquis Khan Jiwanibilquis.khan@state.mn.us

651.201.5404

Merry Jo Thoelemerry.jo.thoele@state.mn.us

651.201.3749

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1 Seal America: The Prevention Invention; Seal in a Smile video

http://www.mchoralhealth.org/seal/video.html

2 Children With Special Health Care Needs

Adapted from Children’s Health Alliance of Wisconsin Seal-a-Smile

Program. Screening form was adapted from the CSHCN Screener ©, a

validated screening tool developed by the Child and Adolescent Health

Measurement Initiative (CAHMI). It is specifically designed to reflect the

broad Maternal and Child Health Bureau definition of children with

special health care needs. Source: Identifying Children With Special Health

Care Needs: Development and Evaluation of a Short Screening Instrument.

2002., C.D. Bethell, D. Read, R.E. K. Stein, S.J. Blumberg, N. Wells, P. W.

Newacheck. http://www.ahrq.gov/professionals/quality-patient-

safety/quality-resources/tools/chtoolbx/bethellscreener.pdf

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References